Toward Fewer Procedures and Better Outcomes

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Abstract
In 1987 and 1988 the Health Program at RAND, Santa Monica, Calif, published a series of articles on the appropriateness of various medical procedures that had been performed between 1979 and 1982.1-3The RAND investigators had developed appropriateness criteria by a specific method in which panels of nine experts reviewed relevant medical literature and then rated a series of clinical scenarios (indications). When the criteria sets were applied to actual patient records, it appeared that a significant percentage of the procedures were unnecessary. The medical and general public pounced on these reports. At last there was evidence that substantial savings might be achieved in health care; and since the savings would derive from the elimination of unnecessary care, there should actually be a concomitant increase in the quality of care. See also pp 753, 761, and 766. In this issue ofThe Journalthere are three more articles4-6